Healthcare Provider Details

I. General information

NPI: 1932165644
Provider Name (Legal Business Name): MARIE ELAINE KOENINGS APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 E PERSHING BLVD
CHEYENNE WY
82001-5356
US

IV. Provider business mailing address

7720 ANTHONY RD
CHEYENNE WY
82009-1542
US

V. Phone/Fax

Practice location:
  • Phone: 307-778-7349
  • Fax:
Mailing address:
  • Phone: 307-637-5118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number56360030
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number717033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: